Healthcare Provider Details

I. General information

NPI: 1942986393
Provider Name (Legal Business Name): JESSICA AHERN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 MAIN ST
MIDDLETOWN CT
06457-2732
US

IV. Provider business mailing address

123 MIDDLE ST
BRISTOL CT
06010-7404
US

V. Phone/Fax

Practice location:
  • Phone: 860-347-6971
  • Fax: 860-638-6831
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number46.006490
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: